1063562700 NPI number — AARTI PANDYA, M.D., P.C.

Table of content: (NPI 1063562700)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063562700 NPI number — AARTI PANDYA, M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AARTI PANDYA, M.D., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063562700
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1309 MILSTEAD ROAD
Provider Second Line Business Mailing Address:
SUITE E
Provider Business Mailing Address City Name:
CONYERS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-929-1333
Provider Business Mailing Address Fax Number:
770-929-0659

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1309 MILSTEAD ROAD
Provider Second Line Business Practice Location Address:
STE E
Provider Business Practice Location Address City Name:
CONYERS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-929-1333
Provider Business Practice Location Address Fax Number:
770-929-0659
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PANDYA
Authorized Official First Name:
AARTI
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
770-929-1333

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  020985 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 047501 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000832785A . This is a "MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000188394D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000832785A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1316916646 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: H00749 . This is a "UPIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 18B0FPC . This is a "MC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 207W00000X . This is a "TAXONOMY CODE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1497724447 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 047501 . This is a "LICENSE #" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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